课件：心律失常总论.ppt

* 内科学教研室心血管内科 * ⑴心脏电除颤电复律 ①体外心脏电除颤电复律 ②体内心脏电除颤电复律 ③自动体外心脏除颤器(AED) * 内科学教研室心血管内科 * * 内科学教研室心血管内科 * * 内科学教研室心血管内科 * ⑵植入型心律转复除颤器 ICD 抗心动过缓起搏 抗心动过速起搏 低能电转复 高能电除颤 * 内科学教研室心血管内科 * * 内科学教研室心血管内科 * ⑶心脏起搏 发放一定形式电脉冲 刺激心脏激动 模拟正常心脏冲动形成和传导 根治缓慢性心律失常 临时与永久性心脏起搏 * 内科学教研室心血管内科 * * 内科学教研室心血管内科 * * 内科学教研室心血管内科 * ⑷经导管射频消融 射频消融仪经导管头端电极接触局部释放射频电能转化热能 达到一定温度后心肌细胞脱水、变性、坏死 根治某些快速性心律失常 * 内科学教研室心血管内科 * * 内科学教研室心血管内科 * * 内科学教研室心血管内科 * ⑸外科手术治疗 切除、隔置、离断参与心律失常形成、维持与传播的心肌组织，保存正常心肌组织，改善心功能 * 内科学教研室心血管内科 * 复习思考题 心脏传导系统各组成部分的结构与功能特点是什么？ 心律失常按发生机制可分为哪两类？ 常见的心律失常有哪些？ 心律失常主要诊断方法有哪些？ 抗心律失常药物分哪几类？ 如何合理应用抗心律失常药物？ 心律失常的非药物治疗方法有哪些？ * A, Sinus tachycardia (150 beats/min) in a patient during acute myocardial ischemia; note the ST segment depression. P waves are indicated by arrows. B, Sinus bradycardia at a rate of 40 to 48 beats/min. The second and third QRS complexes (arrows) represent junctional escape beats. Note the P waves at the onset of the QRS complex. C, Nonrespiratory sinus arrhythmia occurring as a consequence of digitalis toxicity. Monitor leads. * Ventricular flutter and ventricular fibrillation. A, The sine wave appearance of the complexes occurring at a rate of 300 beats/min is characteristic of ventricular flutter. B, The irregular undulating baseline typifies ventricular fibrillation. * A, Radiographs show the position of the ablation catheter (Map) midway between the His bundle (His) and the coronary sinus (CS) catheters in a patient with a manifest right midseptal accessory pathway. Note the proximity of the Map tip electrode to the CS ostium, which is marked by the vortex of curvature in the CS catheter. Also shown are stimulation catheters in the high right atrium (RA) and right ventricular apex (RV). Left panel, 30 -degree left anterior oblique (LAO) view; right panel, 30-degree right anterior oblique (RAO) view. B, Radiographs show the position of the ablation catheter (ABL) advanced into the neck of a CS diverticulum. Contrast agent is injected through another catheter to show the ana